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Presents a letter to the editor on cases of women with systemic lupus erythematosus (SLE) and periorbital oedema in the absence of any identifiable cause. Area of affectation; Manifestations of the SLE; Utilization of magnetic resonance imaging and computed tomography scan.

Lipoprotein(a) (Lp(a)) is considered a vascular pathogen of outstanding importance. High plasma levels of this lipoprotein are associated with premature arterial disease; however, the mechanisms involved have not been clarified. The atherosclerotic process is increasingly regarded as a chronic inflammatory reaction in the arterial wall where oxidation-mediated endothelial injury involving modified forms of low-density lipoprotein (LDL) seems to be a key event. Autoimmune pathways are involved in the progression of atherosclerosis and humoral response to oxidatively modified LDL can be considered among these pathways. A number of factors can be encountered in the pathogenesis of the accelerated arterial disease seen in patients with antiphospholipid (Hughes) syndrome (APS) and systemic lupus erythematosus (SLE). Among these, high levels of Lp(a) have been described in both and increasing evidence indicates that patients with antiphospholipid antibodies (aPL) are under oxidative stress. Recent studies suggest that the so-called 'oxidation theory of atherosclerosis' may also be applied to Lp(a). This fact makes this lipoprotein potentially suitable as a target of the immune system and antibodies reacting against oxidatively-modified Lp(a) by malondialdehyde have been recently described in APS and SLE. It is therefore likely that an immune response to the oxidized moiety of Lp(a) might be influential in the pathogenicity of this lipoprotein and, subsequently, of atherosclerosis. Lupus (2000) 9, 206–209. [ABSTRACT FROM AUTHOR]

We document a study of 65 patients presenting to our clinics, over a 2-year period, with livedo reticularis. All patients were screened for the presence of anti-cardiolipin antibodies and assessed for the presence of central nervous system disease and features of the ‘antiphospholipid’ syndrome, including venous and arterial thromboses and foetal loss. Patients were also assessed for other clinical features such as Raynaud's phenomenon and valvular lesions. Twenty-eight anti-cardiolipin positive patients were compared with 37 anti-cardiolipin negative patients. There was a statistically significant difference in the incidence of cerebrovascular disease (including strokes and transient ischaemic attacks) thrombocytopenia, valvular heart lesions and foetal loss in the anti-cardiolipin positive patients as compared with the anticardiolipin negative groups. [ABSTRACT FROM AUTHOR]

Examines the role of hydralazine in the incidence of patients with positive antinuclear antibody test. Evidence of lower incidence of positive antinuclear antibody test in rapid acetylators; Differences in dose-response in patients; Physical signs and symptoms of patients developing lupus syndrome.

Serial blood samples were taken from eight patients with systemic lupus erythematosus and five normal controls before and after a standard meal containing 20 g of protein. The samples were assayed for circulating immune complexes by the fluid-phase Clq. monoclonal rheumatoid factor and conglutinin-binding assays. No significant differences were seen in the post- as compared to the pre-prandial levels of circulating immune complexes. In neither controls nor patients did circulating complexes appear for the first time within 90 mm after starting the meal. We conclude that if systemic antigen-antibody reactions occur soon after a protein meal they are not detected by the polyethylene glycol-dependent tests in current use and do not appear to influence the immediate clearance of endogenous immune complexes. [ABSTRACT FROM AUTHOR]

Examines the symptoms of Wegener's granulomatosis in Great Britain. Consideration on the duration of symptoms in the diagnosis; Detection of impaired renal function; Presence of anti-neutrophil cytoplasmic antibodies.

We report a 10-year follow-up on 52 patients with raised levels of anticardiolipin antibodies (aCL) who were first seen at our tertiary referral centre in 1986. The clinical and serological features of these 52 patients are described. Thirty-one patients had the antiphospholipid syndrome (APS) in 1986. Nine of these patients (29%) had further thrombotic events during the follow-up period. Of the other 21 aCL positive patients without clinical manifestations of APS, 11 (52%) developed the syndrome over this period. Five patients (10%) died during the follow-up. Close monitoring of patients with connective tissue diseases and aCL is essential as the likelihood of developing antiphospholipid syndrome is high. [ABSTRACT FROM AUTHOR]

Presents several medical studies in Great Britain. Manifestation of metastatic breast cancer as serous effusions; Effect of active chronic otitis media on adults; Incidence of malignant disease in patients with renal transplants.

Describes the major histocompatibility complex in patients with systemic lupus erythematosus in Great Britain. Genetic susceptibility of the disease; Polymorphism of patients with systemic lupus erythematosus; Prevalence of null complement alleles on patients.

We have studied left ventricular function by non-invasive methods in 28 patients with ankylosing spondylitis and 14 with Reiter's disease and compared them with 42 normal subjects. A dilated and poorly contracting left ventricle with abnormal systolic time intervals were found in five (18%) of those with ankylosing spondylitis and two (14%) with Reiter's disease. Our results suggest that the high cardiovascular morbidity and mortality in these diseases may be due to abnormality of the myocardium in the absence of valve disease. [ABSTRACT FROM PUBLISHER]

Examines the correlation between deficiency of factor B and sickle cell anemia. Difference between alternative pathway function and classical pathway function; Effect of deficiency of factor B in the complement system of patients with sickle cell anemia; Relation between total alternative pathway activity and factor B levels.

Examines the effect of dairy products ingestion on patients with rheumatoid arthritis. Increase in synovitis; changes in immune complexes, IgE antibodies and heat-damaged red cell clearance rates; Exclusion of dairy produce from the diet.

Investigates patients with systemic lupus erythematosus and connective tissue disorder in London, England. Association between syphilis and thrombocytopenia; Complications of systemic lupus erythematosus; Occurrence of leg vein thrombosis in patients.

A female patient, currently aged 40, has attended our Lupus Clinic for 8 years with a clinical picture of urticarial vasculitis, joint pains, severe myalgias and abdominal pain which has occurred in bouts at irregular intervals. She has been found to have consistently reduced C4 levels, C1-esterase inhibitor deficiency and a persistent monoclonal band in the gamma region on electrophoresis. Her serum IgA level has been continuously low. Her symptoms have failed to respond to antihistamines and a variety of other measures but have been partially alleviated by immunosuppressive therapy ('pulsed' cyclophosphamide). We believe that this is the first patient described showing this combination of clinical and laboratory features. [ABSTRACT FROM AUTHOR]